The quality of evidence is downgraded by study limitations (unclear allocation concealment), and by imprecise results (few patients).
A Cochrane review included 7 studies with a total of 354 subjects. Interdental brushing in addition to toothbrushing, as compared with toothbrushing alone reduced gingivitis and plaque at one month (table ). This represents a 34% reduction in gingivitis and a 32% reduction in plaque.
| Outcome | Assumed risk (control) | Corresponding risk (intervention) | Participants (studies) |
|---|---|---|---|
| Gingivitis (scale from 0 to 4, mean follow-up 1 month) | The mean gingivitis in the control group was 1.56 | The mean gingivitis in the intervention groups was 0.53 lower (95% CI 0.23 to 0.83) | 62 (1) |
| Plaque (scale from 0 to 5, mean follow-up 1 month) | The mean plaque in the control groups was 2.97 | The mean plaque in the intervention groups was 0.95 lower (95% CI 0.56 to 1.34) | 62 (1) |
Interdental brushing in addition to toothbrushing, as compared with toothbrushing and flossing reduced gingivitis at one month (table ). This translates to a 52% reduction in gingivitis. Although a high effect size in the same direction was observed at three months (SMD -1.98, 95% CI -5.42 to 1.47, 2 studies, n=107), the confidence interval was wide and did not exclude the possibility of no difference.
| Outcome | Assumed risk (control) | Corresponding risk (intervention) | Participants (studies) |
|---|---|---|---|
| 1Re-expressed from SMD into Eastman Interdental Bleeding Index score 2Substantial statistical heterogeneity among studies, I2=79% 3Re-expressed from SMD into the Silness and Löe Plaque Index score 4Substantial statistical heterogeneity among studies I2=85% | |||
| Gingivitis (score 0 or 1, scale from 0 to 1; mean follow-up 1 month) | The mean gingivitis in the flossing groups was 0.23 points1 | The mean gingivitis in the intervention groups was 0.53 standard deviations lower (0.81 to 0.24 lower)2 | 390 (7) |
| Plaque (scale from 0 to 3; mean follow-up 1 month) | The mean plaque in the flossing groups was 1.23 points3 | The mean plaque in the intervention groups was 0.10 standard deviations higher (0.13 lower to 0.33 higher)4 | 326 (7) |
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